Infant formula and bottle-feeding

What is infant or baby formula?

Most baby formula is made from cow’s milk that has been modified so that it suits your baby’s nutritional needs. It’s not the same as cow’s milk.

Why babies need formula rather than cow’s milk

All baby formula has added vitamins, minerals and fats that babies need, which they can’t get from normal cow’s milk.

Also, babies can’t digest and absorb cow’s milk as completely or easily as breastmilk or formula. That’s because the protein level in cow’s milk is too high for babies.

For these reasons, you shouldn’t give cow’s milk to your baby as their main milk drink until your baby is over 12 months old.

Babies under 12 months of age should not have:

normal cow’s milk as a main drink
skim, evaporated, powdered or sweetened condensed milk
dairy alternatives like soy, rice, almond or coconut milk, unless a health professional recommends them.

For most healthy full-term babies, breastmilk or cow’s milk-based baby formulas are recommended until 12 months of age. If you’re thinking of feeding your baby something other than breastmilk or cow’s milk-based formula, talk to your paediatrician, GP or child and family health nurse first.

Stage 1 and stage 2 formulas

Cow’s milk-based baby formulas for babies up to 6 months of age are called stage 1 or starter formulas. You can use stage 1 formulas from 0-12 months old.

From 6 months, you can choose stage 2 or follow-on formula, but you don’t need to change to stage 2. These formulas aren’t better for your baby than starter or stage 1 formulas.

Which baby formula is best?

Every baby formula you can buy in Australia meets strict Australian Standards.

All cow’s milk-based baby formulas are of similar quality and nutritional value, and all suit most babies.

Some brands are more expensive, but no brands are better for your baby than others. And a hospital’s use of a particular brand of infant formula doesn’t mean that the brand is the ‘best’.

You can buy baby formula in powder form or ‘ready to drink’ form. Either is fine for your baby, but ‘ready to drink’ is usually more expensive.

Baby formula with special additives

Some baby formulas have extra ingredients added to them to make them more like breastmilk. But these ingredients won’t necessarily work in the same way as breastmilk in your baby’s body.

Here are some breastmilk ingredients that are added to some baby formula:

LCPs (long chain polyunsaturated fatty acids): these are important for brain and nerve development. But there’s no clear evidence that babies can absorb ingredients like LCPs when they’re added to formula. Formula with added LCPs might be helpful for formula-fed premature babies’ brain development.
Betacarotene: this is a source of vitamin A and anti-oxidants. Most formulas already have added vitamin A and anti-oxidants. There’s no clear evidence that betacarotene formulas are better for your baby.
Prebiotics and probiotics: these can help formula-fed babies grow healthy bacteria in their bowels. The bacteria might help your baby have softer poo and less nappy rash. It might also help reduce the chance of gastroenteritis.

Also note that these formulas might be more expensive than other formulas.

Special baby formulas

For babies under 12 months of age, cow’s milk-based baby formula is recommended over formulas made from soybeans or goat’s milk, or low-lactose or lactose-free formula.

But babies who can’t have cow’s milk-based formula might need special formula. You should use special baby formulas only under medical supervision.

Soy-based baby formula
Some babies can’t have dairy-based products because of allergies or intolerances. Or you might not want to use regular baby formula because of cultural, religious or other beliefs.

There have been some concerns about the effects of phytoestrogens in soy formula on babies. But soy formulas are considered safe to use if your baby needs one.

Soy-based formulas don’t prevent or reduce the risk of your child developing allergies.

Hydrolysed baby formula
Hydrolysed formula is cow’s milk-based formula in which the milk proteins have been broken down into smaller components:

Partially hydrolysed (also called ‘HA’ or hypoallergenic) – in these formulas, the protein is partially broken down. These formulas aren’t suitable if your baby has a cow’s milk protein allergy.
Extensively hydrolysed – in these formulas, the protein is broken down even more. If your baby has a diagnosed cow’s milk protein allergy and you aren’t breastfeeding, your doctor might recommend an extensively hydrolysed infant formula.

There’s no evidence that giving babies hydrolysed infant formula prevents allergy problems from developing, even if you have a family history of allergies.

Prethickened formula and thickening agents
Prethickened (also called ‘AR’ or anti-reflux) formula is cow’s milk-based formula that has a thickener added. You can also buy thickening agents to add to standard baby formula yourself.

Your GP might recommend thickeners or prethickened formula if you’re using formula and your baby has gastro-oesphageal reflux. You should use prethickened formula or thickeners only in consultation with your doctor.

Homemade baby formula
Homemade baby ‘formula’ that uses bone broth and other ingredients, and formula that uses ‘raw’ milk, aren’t suitable alternatives to breastmilk or shop-bought cow’s milk-based baby formula. Homemade baby formula can contain many ingredients that aren’t safe for your baby. Also, it generally won’t have the essential nutrients that your baby needs.

Changing baby formula

Once you’ve settled on a baby formula for your baby, it’s better not to change formula too often. The taste will vary slightly, and it might upset your baby’s feeding routine.

If you do decide to change baby formula, read the directions on the new formula label carefully. Different formulas have different-sized scoops and are made up in different ways.

Toddler formulas

Your baby doesn’t need formula after 12 months.

This includes toddler or stage 3 formulas. At this age, toddlers should be getting most of their nutrition from solid food and can have cow’s milk as a drink.

If toddlers are having toddler formula, it can reduce their appetite for food. This can mean they don’t get the nutrients they need. It can also contribute to fussy eating.

When your baby is around 6 months old, you can start helping your child learn to drink from a cup. You can aim to stop using bottles by the time your baby turns 12 months old.